Search

Abstract Human interactions and perceptions about health risk are essential to understand the evolution over the course of a pandemic. We present a Susceptible-Exposed-Asymptomatic-Infectious-Recovered-Susceptible mathematical model with quarantine and social-distance-dependent transmission rates, to study COVID-19 dynamics. Human activities are split across different location settings: home, work, school, and elsewhere. Individuals move from home to the other locations at rates dependent on their epidemiological conditions and maintain a social distancing behavior, which varies with their location. We perform simulations and analyze how distinct social behaviors and restrictive measures affect the dynamic of the disease within a population. The model proposed in this study revealed that the main focus on the transmission of COVID-19 is attributed to the “home” location setting, which is understood as family gatherings including relatives and close friends. Limiting encounters at work, school and other locations will only be effective if COVID-19 restrictions occur simultaneously at all those locations and/or contact tracing or social distancing measures are effectively and strictly implemented, especially at the home setting.

Introduction Migration figures place Chile as one of the South American countries with the highest rate of migrants. The present study estimated the relationship between sociodemographic characteristics, quality of life, and psychosocial occupational risks in migrant workers from the Maule region. Methods Cross-sectional study with migrant workers between 18 and 60 years of age residing in the Maule region (n = 145). The applied questionnaires were: a psychosocial risk questionnaire, a health and quality of life questionnaire, and a sociodemographic questionnaire. A bivariate statistical analysis was performed using nonparametric Mann-Whitney U tests, Kruskal Wallis, Spearman correlation, and multiple linear regression models. Results In Chile, 21% of the migrants maintained the same work activity as in their country of origin. Although the quality of life in physical and mental health is adequate, 52% have low psychological demands at work, 48.9% have low levels of active work and development skills, 57.7% have a high-risk level of compensation and self-esteem, and 65.5% have a high-risk level of double presence at work. Migrants with a higher quality of life in the physical health dimension have a lower risk of maintaining a balance between effort and reward; they worked 44 hours a week and did not work directly at Maule. Migrants with a higher quality of life in the mental health dimension have a lower risk of emotional demands, perceive greater social support in the company, and are less concerned about domestic chores. Conclusions Migrants with lower quality of life in the physical health dimension presented less compensation at work and recognition, came to work directly in the region, and had jobs with fewer contract hours. Workers with lower quality of life in their mental health exhibited a greater risk of psychological demands at work and perceived low social support in the company; they were concerned about having to respond to domestic and salaried work.

Abstract Modeling human behavior within mathematical models of infectious diseases is a key component to understand and control disease spread. We present a mathematical compartmental model of Susceptible–Infectious–Removed to compare the infected curves given by four different functional forms describing the transmission rate. These depend on the distance that individuals keep on average to others in their daily lives. We assume that this distance varies according to the balance between two opposite thrives: the self-protecting reaction of individuals upon the presence of disease to increase social distancing and their necessity to return to a culturally dependent natural social distance that occurs in the absence of disease. We present simulations to compare results for different society types on point prevalence, the peak size of a first epidemic outbreak and the time of occurrence of that peak, for four different transmission rate functional forms and parameters of interest related to distancing behavior, such as: the reaction velocity of a society to change social distance during an epidemic. We observe the vulnerability to disease spread of close contact societies, and also show that certain social distancing behavior may provoke a small peak of a first epidemic outbreak, but at the expense of it occurring early after the epidemic onset, observing differences in this regard between society types. We also discuss the appearance of temporal oscillations of the four different transmission rates, their differences, and how this oscillatory behavior is impacted through social distancing; breaking the unimodality of the actives-curve produced by the classical SIR-model.

El proyecto USAID Leer es una intervención de lectura y escritura en escuelas públicas de la República Dominicana en respuesta a sus bajos niveles de comprensión lectora. el objetivo del estudio fue determinar la eficacia del proyecto USAID Leer a través de dos estudios transversales (al iniciar el proyecto y en la mitad). Se realizó un estudio experimental con aleatorización de grupos (experimental vs. control) y una estimación del contrafactual basada en la evaluación de línea base. Participaron 2,399 alumnos de segundo grado para línea base, y 2,359 alumnos de cuarto grado para línea media. Se evaluaron comprensión lectora, habilidades precursoras a la misma (comprensión oral, conciencia fonológica, conocimiento de letras, lectura de palabras por minuto, lectura de pseudopalabras por minuto y fluidez), y habilidades cognitivas generales (memoria de trabajo de palabras y memoria de trabajo de pseudopalabras). Dentro de los resultados se destaca que no hubo diferencias entre los grupos durante la línea base. En la línea media, el grupo experimental obtuvo mejores puntuaciones que el grupo control en comprensión oral, conciencia fonológica, conocimiento de letras, lectura de palabras y pseudopalabras por minuto y memoria de trabajo de pseudopalabras. No hubo diferencias entre los grupos en fluidez ni en comprensión lectora. Se concluyó que la intervención fue efectiva, pero aún no ha alcanzado el umbral necesario para que sus efectos se reflejen más allá de las habilidades precursoras de la comprensión lectora. Los resultados se interpretan desde la teoría de la automatización lectora y la necesidad de mayor práctica lectora de los alumnos en proceso de alfabetización.

Foundation: in patients with sickle cell disease, lung function abnormalities are frequent and can be detected by spirometry. Objective: to describe the disturbances of the respiratory functions in patients with sickle cell disease followed in a provincial consultation of hemoglobinopathies. Methods: observational, descriptive, cross-sectional study. Seventy six patients, selected by accidental non-probabilistic sampling, of 88 adults followed at the Dr. Gustavo Aldereguía Lima Hospital were included. The variables studied were: age, sex, type of hemoglobinopathy, respiratory symptoms, history of acute thoracic syndrome, (clinical forms and number of events), comorbidities and ventilatory pattern. Functional ventilatory tests were performed with Hellige digital Microspiro. Results: the age group between 20-29 years was the most frequent (34.2%). There was a discrete female predominance (56.1%) and the SS genotype (67.1%). The most frequent of the respiratory symptoms was dyspnea and among the comorbidities heart failure in 9.2% of the patients. In 42.1% there was a history of acute chest syndrome, pneumonia in most cases. Nine patients (11.8%) presented obstructive disorders and 43 patients (56.6%) a restrictive pattern. In the SS genotype the risk of having spirometry alterations was three times higher than the rest [OR = 3.2 IC (1.7-5.9)] Conclusion: the finding of altered respiratory functional test with a predominance of the restrictive pattern was common. These modifications were observed more frequently in patients with the SS genotype.

Foundation: University students do not consciously assimilate that the system of knowledge of the discipline Society and Philosophy may help them solving new problems and situations using its concepts and logical operations. Objective: describe the student´s perception about the conscious assimilation of the content of the discipline Society and Philosophy, taught with an increment of the productive level. Methods: pedagogical research realized at the University of Medical Sciences, Cienfuegos, from February to July 2018, in four first year groups of the medical career at their Philosophy lessons. There was an increase of the productive assimilation level in the seminar guidelines and practical lessons, on the bases of designing integrating questions. The number of questions decreased. It was applied a survey to the students to confirm the predominance of the assimilation productive method over the reproductive one in the seminaries may strengthen the conscious assimilation of the subject. The measurement was done at concluding the topic related to Marxist-Leninist nosology since it is considered essential to develop the logical thinking of the future health professional. Results: 95% of the students validated the transformation applied to the guidelines of the practical lessons and seminaries, as a way for a better assimilation of knowledge. They acknowledge the importance of the subject for a better understanding of the world and their future profession. Conclusion: it was demonstrated that the level of productive assimilation in frequent evaluation of the discipline Philosophy and Society the university student assumes consciously that the discipline may help them in the solution to many problems and situations using its concepts and logical operations.

Dengue fever is a serious and growing public health problem in Latin America and elsewhere, intensified by climate change and human mobility. This paper reviews the approaches to the epidemiological prediction of dengue fever using the One Health perspective, including an analysis of how Machine Learning techniques have been applied to it and focuses on the risk factors for dengue in Latin America to put the broader environmental considerations into a detailed understanding of the small-scale processes as they affect disease incidence. Determining that many factors can act as predictors for dengue outbreaks, a large-scale comparison of different predictors over larger geographic areas than those currently studied is lacking to determine which predictors are the most effective. In addition, it provides insight into techniques of Machine Learning used for future predictive models, as well as general workflow for Machine Learning projects of dengue fever.

En lo que concierne a salud, la experiencia indica que en toda población humana existe un porcentaje de individuos que se comporta en forma consciente ante la presencia de enfermedades infectocontagiosas. Esto implica que existen grupos con una orientación hacia la prevención en sus actividades para atenuar el riego, mientras que en general la mayoría lo hace distraídamente. La excepción la constituyen los casos de orden catastrófico. Asumiendo el marco teórico y metodológico que otorga la epidemiología matemática, se evaluaron los factores tamaño e intensidad de la conducta del grupo cuidadoso en la determinación del número reproductivo básico, basándose en un modelo tipo SIR (susceptibles - infecciosos - recuperados). Es decir, se midió la reducción en la cantidad de casos secundarios que produciría un primer caso infeccioso. Junto con estos indicadores, se procedió a evaluar la prevalencia evitada total e individual por cada sujeto cuidadoso en diferentes escenarios paramétricos. Finalmente, se plantea la necesidad de integrar en futuros estudios la variable distancia y el contacto interpersonal como factores asociados al potencial de transmisión.

El modelo clásico de la coagulación, propuesto hace más de 40 años, separa las fases celular y humoral de la coagulación. Considera que el proceso de hemostasia se consigue a través de la activación secuencial de enzimas efectoras en dos vías independientes: la extrínseca y la intrínseca. Una nueva teoría, conocida como modelo celular de la coagulación, reemplaza la tradicional hipótesis de las cascadas y enfatiza en las células como elementos esenciales capaces de dirigir el proceso hemostático, mediante la interacción de superficies celulares, factor tisular y factor VII, en tres fases simultáneas: iniciación, amplificación y propagación. En la presente revisión bibliográfica se abunda con detalle sobre la nueva teoría celular de la coagulación, para lo cual se consultaron 33 artículos, con el objetivo de describir los aspectos más importantes de la nueva teoría y sus ventajas respecto a la vieja.

The classical model of coagulation, proposed more than 40 years ago, separates humoral and cellular phases of coagulation. This model assumes that the hemostatic process is achieved through the sequential activation of effector enzymes in two independent ways: extrinsic and intrinsic. A new theory, known as the cell-based coagulation theory, has replaced the traditional hypothesis. In this new theory cells are emphasized as the essential elements capable of directing the hemostatic process, through the interaction of cell surfaces, tissue factor and factor VII in three simultaneous phases: initiation, amplification and propagation. The present literary review presents details on the new cell-based coagulation theory. In this sense, 33 articles were consulted in order to describe the most important aspects of the new theory and its advantages over the previous one.

Recombinant human erythropoietin has been used for more than two decades in clinical practice with promising results in the treatment of anemia associated with chronic renal insufficiency and in patients with cancer. Recent evidence has uncovered new nonhematopoietic functions of this protein and have brought new hope in the treatment of diseases with ischemic component. In the present review is rife with detail about these new features in the light of new discoveries and explores the therapeutic opportunities offered by these new scientific evidence.

Se realizó estudio descriptivo de corte transversal para evaluar las manifestaciones oculares de la drepanocitosis en 64 adultos atendidos en Consulta de Hemoglobinopatías del Hospital Universitario "Dr. Gustavo Aldereguía Lima". Los objetivos fueron: evaluar la frecuencia de las alteraciones oftalmológicas, relacionarlas con parámetros clínico-hematológicos y estimar sus consecuencias funcionales. Se realizó examen oftalmológico completo en condiciones basales. Para el análisis de los datos se usaron estadísticos descriptivos, comparaciones de medias y la prueba chi cuadrado. El signo de la coma fue la alteración más frecuente, se asoció con el genotipo SS y con niveles más bajos de hemoglobina. La tortuosidad de los vasos fue el hallazgo más común en la retina en todos los genotipos, mientras que las opacidades del vítreo y los broches negros en figura de sol, mostraron una asociación estadísticamente significativa en algunos casos. Se diagnosticó retinopatía falciforme no proliferativa en la mayoría de los enfermos estudiados y en varios de ellos se demostraron hallazgos de ambos tipos de retinopatías. A pesar de las numerosas lesiones demostradas, la agudeza visual se clasificó como buena en el 94,6 % de los ojos examinados.A cross-sectional and descriptive study was carried out to assess the ocular manifestations of drepanocytemia in 64 adult patients seen in Hemoglobinopathy of "Dr. Gustavo Aldereguía Lima" University Hospital. The aims of present paper were: to assess the ophthalmologic alterations frequency related to clinical-hematological parameters and to estimate its functional consequences. A basal total ophthalmologic examination was performed. For data analysis descriptive statistical models, mean comparisons and the Chi² test. The decimal point sign was the more frequent alteration associated with SS genotype and with lower hemoglobin levels. Vessel tortuous was the commonest finding in retina in all genotypes, whereas the vitreous body opacities and the black cupping in sun shape showed a statistically significant association in some cases. A non-proliferative retinopathy was diagnosed in most of study patients and in some of them the findings of both types of retinopathy were showed. Despite the numerous lesions showed, visual acuity was qualified as good in the 94,6% of study eyes.

Bakground: Neutropenia and infections are the most restrictive side effects in chemotherapy application. The granulocytic colonies stimulating factor activates the neutrophils, shortens the neutropenic period and can be effective against the potential risk of infection. There is a need of studies for its commercialization to endorse their effectiveness and security. Objective: To evaluate the impact of the G-CSF in primary and secondary prevention and neutropenia episodes, in onco-haematological patients in Cienfuegos. Method: 95 neutropenic episodes were studied, picked up in clinical histories and data collection notebooks belonging to 47 patients treated in the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ in Cienfuegos and happened during one year (2005-2006). It was analyzed: demographic data, absolute neutrophils count values, number of administered doses, treatment regime and possible treatment interruptions Results: 50, 5% received treatment in an ambulatory way. There was treatment interruption in 9 episodes, 9,5% and the mean dose number administered to obtain the recovery of neutrophils absolute count was 6,69. Conclusions: The product was effective, sine the decrease of neutropenic episodes could be verified, as the elevation of neutrophil values in approximately one week, what allowed a better pursuit of chemotherapy to patients of the studied series.AbstractTo demonstrate the effectiveness of Leukocim an open, phase IV clinical trial was designed, 39 patients from Cienfuegos were evaluated with 73 neutropenic episodes in primary or secondary prophylaxis or treatment, the demographic parameters behaved with an age 49.86 year old average, the predominant sex was the feminine 64.38%, 73.97% belonged to the white race, when the effectiveness was analyzed we obtained that 46.5% received the treatment in an ambulatory way, whereas 52.1% was hospitalized; one patient abandoned before beginning the treatment, the 12,3% of patients abandoned the study, the dose number received in order to correction CAN was between 3 and 7, behaving with a stocking of 1.26 before receiving the treatment and of 5.82 after the same one receiving the next cycle chemo y/o radiotherapy in time demonstrating this way the effectiveness of the product.

Background: The survival of patients with multiple myeloma varies. Frequently we don’t identify the patients that could be cured with advanced therapies, nor even recognize those, in which we expect a long survival with the classic treatment measures. That’s why it is necessary the study of prognosis factors to achieve an optimum stratification and to individualize the pattern to follow. Objectives: To determine the 3 years survival of the patients with multiple mieloma and the factors that influence it. Methods: A descriptive study of a series of cases of 50 patients with multiple mieloma. The socio-demographic characteristics were studied, as well as the clinic-humoral state, type of treatment and response to it, the over life curves were calculated by the estimates of Kaplan-Meier. A uni-varied analysis was made for which the patients were stratified in groups, that were compared through the long-rank method. A trust interval of 95% was accepted. Results:The total 3 years survival was of 37%. The 58% of the cases used the combination of Melfalan with Prednisona as initial therapeutic scheme. The 47,1% of the treated patients had a positive response to the chemotherapy. There were no alarming differences in response percentage and in survival among those who received Melfalan-prednisona and those who were treated with schemes that combined both drugs. The functional capacity reduction, the association to renal insufficiency, and not having response to treatment were the factors associated to an early mortality. Conclusions: The identification by means of this study of the factors related with the illness, would allow us to stratify the sick persons and to individualize its cares to improve the survival.

Las investigaciones básicas y clínicas realizadas en los últimos años sobre las células madre y sus posibilidades terapéuticas, son en la actualidad uno de los temas más excitantes de la medicina contemporánea. Ya se han obtenido importantes avances en el estudio y aplicación de las células madre adultas que muestran notables ventajas sobre las embrionarias, pues su manipulación resulta más simple, económica y se pueden obtener del propio individuo que va a ser tratado. Para la introducción en Cuba de la terapia celular regenerativa, en el Instituto de Hematología e Inmunología se seleccionaron como fuentes celulares las células madre adultas derivadas de la médula ósea y las movilizadas a la sangre periférica. Para facilitar la extensión del tratamiento a otros centros hospitalarios, se estandarizó una técnica para la movilización de las células madre hematopoyéticas a la sangre periférica, mediante un factor estimulador de colonias de granulocitos (Filgrastim, de producción nacional) y se desarrolló un método simple, económico y también más tolerable para los enfermos. De esta forma, se ha extendido la terapia celular a 6 provincias cubanas y hasta abril del año 2009 se habían tratado 563 casos con trasplante de células madre adultas autólogas, de los cuales el 81,7 % corresponde a pacientes con enfermedades angiológicas, en los que se ha logrado disminuir significativamente la indicación de amputaciones mayores. También los resultados han sido muy prometedores en las lesiones óseas y procesos periodontales, entre otras enfermedades tratadas. Los resultados obtenidos hasta el momento se pueden considerar como un nuevo logro de la ciencia revolucionaria y de nuestros sistemas nacionales de salud y de ciencia y técnica. El método empleado es un proceder económico y factible para instituciones con recursos limitados.

La linfadenitis necrotizante histiocitaria o enfermedad de Kikuchi-Fujimoto es un proceso benigno poco frecuente. Se presentaron 2 casos diagnosticados con poco tiempo de aparición entre uno y otro. El primero fue una mujer blanca, de 26 años, con astenia, pérdida de peso, sudación nocturna, escalofríos, prurito generalizado y anorexia. Al realizar examen clínico se demostró la presencia de adenopatías y en los exámenes de laboratorio no se halló nada significativo. Se obsevaron varias estructuras ganglionares pequeñas con preservación parcial de la citoarquitectura y cambios hiperplásticos ligeros. El segundo paciente, un hombre negro, de 34 años, que se presentó con fiebre vespertina, escalofríos, odinofagia, cefalea y dolores articulares. Se observó orofaringe enrojecida con aumento del tamaño de las amígdalas, sin exudados y adenopatías en la cadena lateral derecha del cuello y submaxilares. No se encontró ningún resultado anormal en los estudios de laboratorio y en el examen histológico del ganglio se observó preservación casi total de su arquitectura, con cambios hiperplásticos corticales y paracorticales. Se observó remisión clínica espontánea en ambos enfermos.Histiocytic necrotizing lymphadenitis or Kikuchi-Fujimoti disease is a rare benign process. Two cases diagnosed with little time of appearance between one and other were presented. The first one was a 26-year-old white female with asthenia, weight loss, night sweating, chills, generalized pruritus and anorexia. On the physical examination, it was proved the presence of adenopathies, and nothing signficant was found in the lab tests. Various small ganglionar structures with partial preservation of the citoarchitecture and mild hyperplastic changes were observed. The second patient, a 34-year-old black male, presented morning fever, chills, odynophagia, headache and articular pain. It was deteced a reddened oropharynx with increase of the size of the tonsills , without exudates and adenopathies on the right lateral chain of the neck and submaxilla . No abnormal result was reported in the lab studies. In the histological examination of the ganglion, it was observed a nearly total preservation of its architecture, with hyperplastic cortical and paracortical changes. A spontaneous clinical remission was noticed in both patients.

Se presenta el caso de un hombre de 64 años que ingresó por dolor torácico, disnea, astenia, anemia y leucocitosis ligeras. En la radiografía se comprobó derrame pleural en hemitórax izquierdo, con masa tumoral en su tercio superior, hallazgos que fueron confirmados en la tomografía axial computarizada. El estudio del líquido pleural evidenció la presencia de plasmocitos y de un pico monoclonal en la zona de las g globulinas. En suero también se demostró un aumento monoclonal de estas proteínas y en la médula ósea un 41 % de células plasmáticas. Con estos elementos se diagnosticó un mieloma múltiple IgG y se inició quimioterapia con melfalán y prednisona. El paciente falleció un año después por progresión de la enfermedadThe case of a 64-year-old man that was admitted due to thoracic pain, dyspnea , asthenia, anemia and mild leukocytosis is presented. In the chest X-ray, it was observed a pleural effusion on the left hemithorax, with tumoral mass in its superior third, findings that were confirmed by CAT. The study of the pleural fluid evidenced the presence of plasmocytes and of a monoclonal peak in the zone of the g globulins. A monoclonal increase of these proteins was also detected in serum, whereas 41 % of plasmatic cells were found in the bone marrow. Based on these elements, a multiple IgG myeloma was diagnosed and chemotherapy with melphalan and prednisone was started. The patient died a year later as a result of the disease progression